Disparities in the Evaluation and Diagnosis of Abuse Among Infants with Traumatic Brain Injury

This article analyzes whether screening for child abuse among infants with traumatic brain injury is associated with the race or socioeconomic status of the infant. Traumatic brain injury from child abuse is a serious health risk for children, particularly for infants. The American Academy of Pediatrics recommends that all potential victims of infant abuse be screened for skeletal fractures, but this recommendation is inconsistently enforced.

The authors analyzed data from the Pediatric Health Information System, which collects information from 40 pediatric hospitals representing over 70 percent of all pediatric hospitals in the United States. The sample included 3,063 infants admitted with traumatic brain injury between January 2004 and June 2008.

Key Findings:

  • Skeletal surveys were conducted on 72 percent of infants with traumatic brain injury. Thirty-seven percent of infants with traumatic injury received a diagnosis of child abuse.
  • Infants who were Black, had public insurance or no insurance, were male, or were older than one month were more likely to be screened for skeletal injuries.
  • White infants were less likely to be screened for abuse than Black or Hispanic infants. White infants who received a skeletal screening were more likely to be diagnosed with abuse than Black or Hispanic infants.

This research shows that Black and Hispanic infants with traumatic brain injury are more likely to be screened for child abuse than White infants, but that White infants who receive the screening are more likely to be diagnosed with child abuse than Black or Hispanic infants. This suggests that a threshold for child abuse may vary by race and may contribute to the over-evaluation of non-White infants or the under-evaluation of White infants with traumatic brain injury.

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